BACKGROUND
Thyroid cancer is the most common endocrine cancer in the US. Most people do very well with treatment, but not everyone has the same good outcomes. Past studies have shown that Black and Hispanic patients often have worse results during thyroid cancer treatment. These differences may have multiple causes. For example, some patients may not receive the standard treatments recommended for their condition, or they may be treated by surgeons who perform fewer thyroid operations, which can increase the risk of complications. While past studies have shown differences in outcomes, they often did not specify which types of surgery were done or how this affected the results. Medical factors like the cancer type and size, and whether it has spread, can strongly affect treatment and survival. Social and economic factors like education, income, health insurance, and where someone lives may also affect when and how people are diagnosed or treated. These are called social determinants of health and have not been studied as well.

The researchers wanted to better understand why thyroid cancer outcomes differ across racial and ethnic groups. They measured how much cancer type, treatment differences, and social factors contributed to these differences. They also examined whether the type of surgery patients received affected their chances of doing well.

THE FULL ARTICLE TITLE
Fwelo P et al. Disparities in thyroid cancer mortality across racial and ethnic groups: assessing the impact of socioeconomic, clinicopathologic, and treatment variations. Ann Surg Oncol 2025;32(2):1158-1175; doi: 10.1245/s10434-024-16569-y. PMID: 39614001

SUMMARY OF THE STUDY
This study looked at information from 109,981 people in the US who had surgery for thyroid cancer between 2006 and 2018. The researchers used a large national database with information about cancer diagnosis, treatment, and outcomes. They used a step-by-step approach to see how different factors influenced the results. First, they looked at basic differences, like age, sex, and marital status. Then they added medical details about the cancer itself, like cancer type and how far it had spread.

After that, they looked at differences in treatment. Finally, they added social and economic factors, like where someone lives and their income level. They repeated this process for both thyroid cancerrelated deaths and overall deaths, using a special analysis to measure how much each factor explained the differences.

The study found differences in the type of treatment patients received based on race and ethnicity. Hispanic patients were the most likely to receive the recommended kind of surgery (79%), while non-Hispanic Black patients were the least likely (68.9%). People with more advanced cancer were more likely to receive the recommended surgery than those with early-stage cancer (96.6% vs 63.7%). Non-Hispanic Black patients had a higher risk of dying from any cause. Hispanic patients appeared to have a higher risk of dying from thyroid cancer, but when researchers accounted for the socioeconomic factors, this risk was no longer higher. Medical details about the cancer itself explained most of the higher risk seen in Hispanic patients. For non-Hispanic Black patients, social and economic factors explained nearly half of the difference in thyroid cancer-related deaths.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
These findings support earlier research showing that thyroid cancer care and outcomes can differ across racial and ethnic groups. Using a large national database and detailed analysis, the study was able to measure how much of these differences were explained by medical factors like cancer type and treatment, as well as social and economic factors. However, because the study used medical records, it lacked information on why some patients did not get the standard treatment and could not account for other factors like additional health problems, access to care, or trust in the healthcare system.

This study reminds us how important it is for patients and their healthcare teams to talk openly, not only about the cancer but also about any challenges patients face in getting care. It also highlights the need for care that focuses on the whole person, not just the diagnosis.

— Ebru Sulanc, MD

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